title: Unexpected symptoms after rhTSH administration due to occult thyroid carcinoma metastasis.
abstract: ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸FDG-PET) scintigraphy is a useful imaging technique in the evaluation of metastasised thyroid carcinoma. Administration of recombinant human thyrotropin (rhTSH, Thyrogen®) increases the diagnostic yield of this procedure. Here we present a 64-year-old male who was followed for Hürthle cell carcinoma of the thyroid with several intrapulmonary metastases. He developed sudden complaints of neck pain following rhTSH administration as part of the routine preparation for a diagnostic ¹⁸FDG-PET÷CT procedure. This investigation subsequently revealed a previously undetected metastatic lesion in the first cervical vertebra, with no signs of spinal cord compression. Treatment with a nonsteroidal anti-inflammatory drug reduced the symptoms sufficiently, and a few weeks later the neurosurgeon performed a complete resection of the metastasis. It is likely that the symptoms were caused by oedema and÷or increased blood flow to the lesion. Physicians should be aware that rhTSH administration to patients with disseminated thyroid carcinoma may lead to sudden onset of symptoms caused by previously occult metastases.
authors.affiliation: Department of Endocrinology & Metabolism, University of Groningen & University Medical Center Groningen, The Netherlands. bwo@umcg.nl
authors.forename: B H R
authors.initials: BH
authors.lastname: Wolffenbuttel
authors.forename: M H
authors.initials: MH
authors.lastname: Coppes
authors.forename: A H H
authors.initials: AH
authors.lastname: Bongaerts
authors.forename: A W J M
authors.initials: AW
authors.lastname: Glaudemans
authors.forename: T P
authors.initials: TP
authors.lastname: Links
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging* / Q000556:secondary; D018249:Adenoma, Oxyphilic; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D013125:Spinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000556:secondary; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D057073:Thyrotropin Alfa / Q000009:adverse effects*
chemical_list: D019275:Radiopharmaceuticals; D057073:Thyrotropin Alfa; D019788:Fluorodeoxyglucose F18